| NPI | 1174599195 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CA C54055) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: TX l8522) |
| Enumeration Date | 2006-02-28 |
| Last Update Date | 2012-01-06 |